title: Preference-based Health status in a German outpatient cohort with multiple sclerosis.
abstract: BACKGROUND
  To prospectively determine health status and health utility and its predictors in patients with multiple sclerosis (MS).
  
  
  METHODS
  A total of 144 MS patients (mean age: 41.0 ± 11.3 y) with different subtypes (patterns of progression) and severities of MS were recruited in an outpatient university clinic in Germany. Patients completed a questionnaire at baseline (n = 144), 6 months (n = 65) and 12 months (n = 55). Health utilities were assessed using the EuroQol instrument (EQ-5D, EQ VAS). Health status was assessed by several scales (Expanded Disability Severity Scale (EDSS), Modified Fatigue Impact Scale (M-FIS), Functional Assessment of MS (FAMS), Beck Depression Inventory (BDI-II) and Multiple Sclerosis Functional Composite (MSFC)). Additionally, demographic and socioeconomic parameters were assessed. Multivariate linear and logistic regressions were applied to reveal independent predictors of health status.
  
  
  RESULTS
  Health status is substantially diminished in MS patients and the EQ VAS was considerably lower than that of the general German population. No significant change in health-status parameters was observed over a 12-months period. Multivariate analyses revealed M-FIS, BDI-II, MSFC, and EDSS to be significant predictors of reduced health status. Socioeconomic and socio-demographic parameters such as working status, family status, number of household inhabitants, age, and gender did not prove significant in multivariate analyses.
  
  
  CONCLUSIONS
  MS considerably impairs patients' health status. Guidelines aiming to improve self-reported health status should include treatment options for depression and fatigue. Physicians should be aware of depression and fatigue as co-morbidities. Future studies should consider the minimal clinical difference when health status is a primary outcome.
authors.affiliation: Department of Neurology, Philipps-University, Marburg, Germany. dodel@med.uni-marburg.de.
authors.forename: Jens Peter
authors.initials: JP
authors.lastname: Reese
authors.forename: Gabriele
authors.initials: G
authors.lastname: Wienemann
authors.forename: Axel
authors.initials: A
authors.lastname: John
authors.forename: Alexandra
authors.initials: A
authors.lastname: Linnemann
authors.forename: Monika
authors.initials: M
authors.lastname: Balzer-Geldsetzer
authors.forename: Ulrich Otto
authors.initials: UO
authors.lastname: Mueller
authors.forename: Christian
authors.initials: C
authors.lastname: Eienbröker
authors.forename: Björn
authors.initials: B
authors.lastname: Tackenberg
authors.forename: Richard
authors.initials: R
authors.lastname: Dodel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005858:Germany; D006304:Health Status; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D010045:Outpatients / Q000523:psychology*; D057240:Patient Preference / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult